Colorectal cancer is the second most common cause of cancer death in the United States. Early detection and intervention can significantly reduce morbidity and mortality from colorectal cancer (CRC). Individuals with a family history of CRC are at increased risk for the disease, and should have screening at younger ages and/or with increased frequency than the population at large. They also may benefit from personalized cancer risk counseling. This proposal is a competing continuation application that builds on an exploratory study of psychosocial and ethnocultural factors related to intentions to obtain genetic testing for heritable colon cancer, and a pilot study of genetic counseling for intermediate-risk CRC family members. The specific aims of the study are to: (1) evaluate the impact of a culturally sensitive program of Colon Cancer Risk Counseling (CCRC) on: a) adherence to guidelines for early detection for CRC, b) comprehension of personal colorectal cancer risk, and c) psychological adaptation to familial cancer, among individuals with family history of colorectal cancer (CRC); (2) evaluate the impact of CCRC on subgroups of persons at different levels of risk, various ages and educational levels, males vs. females, and persons of different ethnic groups; and (3) examine the extent to which risk comprehension and psychological adaptation mediate the impact of CCRC on adherence to screening. Subjects will be 700 siblings and children, aged 40 and over, who have a positive history of colorectal cancer (CRC) in one first-degree relative. Subjects will be randomly assigned to receive either: (1) Colon Cancer Risk Counselling or (2) a General Health Counseling control. The theoretical foundation of the intervention and evaluation uses constructs from the Precaution Adoption Model and the Transactional Model of Stress and Coping. Both models concern how individuals perceive threatening situations, and which factors determine whether they take protective action or engage in adaptive coping behaviors. The CCRC intervention will be an individual face-to-face counseling session that emphasizes communication of individualized CRC risk, addresses perceived benefits of and barriers to early detection, and assists participants in developing action plans for appropriate screening; plus 2 follow-up phone calls. The General Health Counseling (GHC) control will address health promotion related to diet, exercise, tobacco use, and screening. Surveys at baseline, 4 months and one year post-intervention will assess the impact of the interventions on colorectal screening adherence, risk comprehension, and psychological adaptation. If effective, the CCRC interventions for these persons at increased risk for colorectal cancer, for whom predictive genetic testing and genetic counseling are usually not available, can be provided in primary care settings or family cancer risk programs.